Healthcare reform vote: House Speaker Nancy Pelosi (D-Calif.) addresses her weekly news conference with reporters in Washington Thursday. Pelosi on Friday said that when the House of Representatives votes on the healthcare reform bill, lawmakers will have assurance that the legislation will also be passed by the Senate.

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Washington

The book is closed on major changes to healthcare reform, Democratic leaders say, as the House moves toward a historic vote on Sunday. But it’s still in flux whether they have the 216 votes needed for passage.

Rep. Peter DeFazio (D) of Oregon, one of the most liberal members of the Democratic caucus, stunned colleagues Friday by announcing that he – and others – would vote no, unless changes are made in a Medicare reimbursement rate that disadvantages his state.

Those changes were in the House version of healthcare reform, voted on in November 2009. They were also included in a draft package of “fixes” to be voted on by the House and sent to the Senate for a vote next week. But at midday Friday, House leaders pulled the language, after objections from some senators that the fix could not survive procedural challenge on the Senate floor.

“I believe they can fix anything they want to. The Senate parliamentarian works for the Senate,” Representative DeFazio said. “I’m not going home to tell my voters that they have a great new Medicare entitlement, but there won’t be any doctors willing to see them,” because the federal payments are so low, he said.

At issue for many late deciders are high-stakes negotiations between the House and Senate over the final content of the “fixes.” House and Senate Democrats want to ensure that whatever passes the House can also make it over the high procedural hurdles in the Senate. Without identical language in both the House and Senate, there is not a healthcare reform bill.

“Whenever you get a critical vote coming forward and there’s some question about what will happen and every marginal vote matters, the temptation to use that for leverage is too great for an awful lot of members,” says Norman Ornstein, resident scholar at the American Enterprise Institute in Washington.

For Rep. Bobby Rush (D) of Illinois, the tipping point could be a program of discounts on prescription drugs for poor people, also pulled after objections from the Senate. “This program covers a sliver of our citizenry that have no voice,” he said. “I’ve moved from leaning undecided to very undecided,” he told reporters Friday afternoon.

Still another bloc of some dozen Democrats is threatening to flip from yes to no because Democratic leaders are not including a “fix” for the Senate bill’s language on abortion. These Democrats see the Senate bill as leaving open the possibility of taxpayer dollars funding abortion.

“We are still working on clarifying the issue,” said Rep. Marcy Kaptur (D) of Ohio, who voted yes last November for the House healthcare bill but now says she is undecided, pending a decision from House leaders on the abortion language.

“This is a very personal vote,” says Rep. Brad Ellsworth (D) of Indiana, who voted “no” before but says he is open to a yes vote if the abortion language can be clarified. “I don’t know if it can be,” he adds.

“I am very excited about the momentum that is developing around the bill,” said Speaker Pelosi at a midday briefing on Friday. “With the release yesterday of the [Congressional Budget Office] figures, now people have seen the bill, have seen the score. The list of supporters grows.”

Pelosi said she is working on language to resolve the Medicare payments issue but does not plan to include new abortion language in the package of fixes to be sent to the Senate.

At the time of writing, the speaker was meeting with House Democrats who oppose federal funding of abortion in a bid to ease their concerns.

“This bill is about healthcare, not about abortion.... So if you don't want federal funding, and you want the status quo for abortion access, and you want to pass a healthcare bill, this is it,” she said.